后腹腔镜肾癌根治术治疗局限性肾癌的临床疗效

Clinical efficacy of retroperitoneal laparoscopic radical nephrectomy in treating localized renal cell carcinoma

摘要:

目的：评价后腹腔镜肾癌根治术（Laparoscopic radical nephrectomy，LRN）治疗局限性肾癌的临床疗效。方法：回顾性分析134例局限性肾癌患者的一般临床资料，比较后腹腔镜组66例（LRN组）与同期传统开放肾癌根治术（Open radical nephrec－tomy，ORN）手术组68例（ORN组）治疗局限性肾癌的临床疗效。结果：2组患者的年龄、性别、肿瘤最大直径、肿瘤部位、肿瘤分期、病理诊断差异无统计学意义（P>0.05），而2组手术时间、术中出血量、术后肠功能恢复时间、住院时间、并发症发生率等差异有统计学意义（P<0.05）。随访3～40月，4例远处转移：2例接受免疫治疗加索拉非尼靶向治疗，病情稳定；2例接受免疫治疗，其中1例进展，1例死亡。结论：后LRN治疗局限性肾癌与传统开放手术的肿瘤控制效果相近似，但具有微创和恢复快等优点，术后复发转移者应首选索拉非尼等靶向治疗。

Abstract:

Objective：To evaluate the clinical efficacy of retroperitoneal laparoscopic radical nephrectomy （LRN） in treating localized renal cell carcinoma. Methods：134 cases of renal cell carcinoma were reviewed for their diagnosis and treatment；the clinical data of 66 cases （group LRN） with renal neoplasm received retroperitoneal LRN and 68 cases （group ORN） with renal neoplasm received open radical nephrectomy were retrospectively analyzed. Results：There was no significant difference between the two groups about in age，sex，max diameter of tumor，tumor location，tumor stage and pathologic diagnosis （P>0.05）. But for the clinical effect indexes，such as operating time，blood loss，recovery time of bowel function，hospital stay and complication incidence rate，the LRN group was sig－nificantly different from ORN group（P<0.05）. The follow-up was 3～40 months.4 cases had distant metastasis；2 patients received im－munotherapy plus sorafenib targeted therapy and kept progression-free survival，while 2 patients received only immunotherapy，1 of whom died of tumor metastasis and 1 had tumor progression. Conclusion：Retroperitoneal LRN with minimal invasion and rapid re－covery，has a similar oncologic effect for localized renal cancer with traditional open surgery. Sorafenib targeted therapy should be pre－ferred for patients with post-operative recurrence or metastasis.